GENERIC NAME: dicyclomine

BRAND NAME: Bentyl

DRUG CLASS AND MECHANISM: Dicyclomine is an anticholinergic drug, a medication that reduces the effect of acetylcholine, a chemical released from nerves that stimulates muscles, by blocking the receptors for acetylcholine on smooth muscle (a type of muscle). It also has a direct relaxing effect on smooth muscle. It is used to treat or prevent spasm in the muscles of the gastrointestinal tract in the irritable bowel syndrome. Dicyclomine was approved by the FDA in 1950.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Capsules: 10mg. Tablets: 20mg.

STORAGE: Capsules and tablets should be stored at room temperature, between 15° (59°F) and 30°C (86°F).

PRESCRIBED FOR: Dicyclomine is used in the treatment of irritable bowel syndrome .

DOSING: Dicyclomine may be taken with or without food. It is usually given 3 or 4 times daily.

DRUG INTERACTIONS: Additive anticholinergic effects may be seen with some antihistamines [carbinoxamine (Rondec), clemastine (Tavist), diphenhydramine (Benadryl), promethazine (Phenergan)], some phenothiazines [e.g. thioridazine (Mellaril), triflupromazine (Stelazine)], some tricyclic antidepressants [e.g. amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), protriptyline (Vivactil)], clozapine (Clozaril), cyclobenzaprine (Flexeril), and disopyramide (Norpace). The added effects of these drugs lead to a greater incidence of dry mouth, blurred vision, confusion, agitation, increased heart rate, heart palpitations , constipation , urinary retention, and seizures than when dicyclomine is used alone. Narcotics [e.g., oxycodone (Percocet, Percodan), hydrocodone (Vicodin)] can interact with dicyclomine and result in greater depression of the muscles of the bowel and bladder resulting in greater constipation and difficulty urinating than may been seen with dicyclomine alone.

Dicyclomine adds to the sedating effects of alcohol and other drugs that cause sedation such as the benzodiazepine class of anti-anxiety drugs (e.g., Valium, Ativan, Klonopin, Xanax), the narcotic class of pain medications and its derivatives (e.g., Percocet, Vicodin, Dilaudid, Codeine , Darvon), the tricyclic class of antidepressants (e.g., Elavil, Tofranil, Norpramin), and certain antihypertensive medications (e.g., Catapres, Inderal).

Dicyclomine can reverse the effects of cisapride (Propulsid) or metoclopramide (Reglan) on gastrointestinal motility. Conversely, these latter two drugs can reverse the effects of dicyclomine.

Antacids and absorbent anti-diarrheals (e.g., Kaopectate) can decrease the absorption of dicyclomine. Therefore, doses of antacids or absorbent anti-diarrheals should be separated by at least 2 hours from doses of dicyclomine.

PREGNANCY: Between 1956 and 1976, dicyclomine was one of the components of Benedictin, a combination of medications used to treat pregnancy-associated nausea. Benedictin was reformulated in 1976, and dicyclomine was removed when it was shown that it did not contribute to the nausea suppressing effect of Benedectin. Dicyclomine appears to be safe during pregnancy in both animal studies and in extensive human use.

NURSING MOTHERS: Dicyclomine is excreted into breast milk. Since there have been reports of apnea (cessation of breathing) when dicyclomine has been given to children, it should probably not be used by nursing mothers.

SIDE EFFECTS: The most common side effects occurring with dicyclomine are due to its anticholinergic activity: dry mouth, blurred vision, confusion, agitation, increased heart rate, heart palpitations, constipation, difficulty urinating, and occasionally seizures can occur. Other potential side effects include changes in taste perception, difficulty swallowing, headache, nervousness, drowsiness, weakness, dizziness , impotence , flushing, difficulty falling asleep, nausea, vomiting, rash, and a bloated feeling.

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